End of the first week

Here's a picture of Laura at the "gas station", which involves driving out a narrow dock with no railings, turning around, and then backing up precisely over a metal plate in the dock. But it's open from 12 to 4 on some days. There are a surprising number of vehicles on the island considering that there are only a few miles of roads, total.
One of the biggest boats getting ready for the season; it pulled up to the gas dock as we were gassing up the neighbor's rig.

This is one of my dog friends, Puddin', on our walk today. Another dog took her place when she decided that she was needed elsewhere, a handsome and personable mutt of indeterminate pedigree, but I didn't get a picture of him. My preceptor, Laura, who going to be 50 this year, has inspired me to start running again, but this time I'm going to take it very slowly and use arch supports so that I don't get plantar fasciitis.

It has been in the 40s and maybe up to the low 50s, and drizzly, for days now. But today is reasonably dry and the wind isn't HOWLING like it seems to do most of the rest of the time. Planes didn't get in here for several days, because they fly on visibility only and there wasn't any of that to be had. But the ferry came in I hear--everyone is excited that they'll be running twice a month now instead of just once. I didn't get to see it.

Last night the local church had the annual fisherman's potluck to kind of bless and honor the fisher people before the start of the season. There was quite a spread, and many fisher folk and non-fisher folk were well fed. The fish was amazing! Salmon cakes, broiled salmon, fish pie--which is a traditional Russian dish that is pretty much just like chicken pot pie but not as soupy and made with--fish!
I know I keep putting up pictures of the same views, but the photos just don't do justice to the immense beauty of this place! I took this along the way with my walk with Puddin' today, and then on in to the clinic to do homework and post this missive.
This is the xray room. What you can't really see is the digital equipment, which is state of the art. The xrays are immediately available for viewing, and because they are digital, you can manipulate to some degree--lighten or darken for better contrast, zoom in, etc. These also get automatically transmitted to the hospital in Anchorage to be read by a radiologist. We have no xray tech here--techs R us.
This is a picture of the ER. I was here just last night--oh wait, it was actually early this morning. We had an emergency call for a Type 1.5 diabetic (remember your endocrinology, all you health care people! hint: AKA LADA; for all you lay people, it doesn't matter) whose blood sugar had dropped so low that he was unconscious. When we got him in here it was 64, but he was really out of it and testing within the next few minutes showed it to be 31! That's very low; that's like SEIZURE AHEAD if not treated immediately. We stuck some glucose gel in his mouth under his tongue, got an IV started and got some glucose going in. It's pretty amazing to watch how quickly hypoglycemia can be reversed. In less than half an hour he was alert, oriented and very apologetic about the whole thing. He scared the peewaden out of his wife and two grown sons. It's nice when things can resolve so well, so quickly.
Teleheath cart; this is an interesting (and very expensive) piece of technology! Right now it doesn't have the capability to go live, but may in the future. What it does is capture data like heart sounds, pictures of the inside of ears, pictures and recordings of a patient, etc., and save them in a "case" that can then be emailed to Anchorage to the Alaska Native Medical Center for review by specialists or ER docs or the like.
Tribe's flag hanging in conference room. It's been a good week! Thai will only be here until Thursday and then another PA comes in--quite a different sort from Thai, I hear. Blake (my younger son who is on a Hotshot (elite) wildland fire crew) is in Fairbanks, AK as of last night. He called me after his AK orientation, and was going to be headed out to somewhere in the surrounding area. I'm pretty excited for him--that is exactly how and where I first came to Alaska! I miss my friends and family and dogs and cat, but I'm still glad to be here. Emails, comments, phone calls and care packages will be rapturously received!
Teresa

pictures to go with the May 27 post

Above: Thai, Casanova and Evan on their way to a hike; below, from top: me in front of Le Manguier (left), the road to the harbor (right)
EAT Clinic from my apartment (L), the view toward the harbor from my apartment (R);
fish traps (L), the view from Salmon Ranch (R), the path between Sand Dollar beach and Salmon Ranch beach through the slot
If any veteran bloggers can tell me how to insert pictures WHERE I WANT THEM in the body of the text, let me know! This is driving me crazy!

Thursday May 27

After the DU dinner (10 PM!) and Unga Island from the airport (right)

Thursday May 27, 2010

Wow, so much to tell! I have been busy, and right now am in HEAVEN after receiving my Full Circle Farm CSA box (fresh, organic produce and groceries shipped from Seattle) and making a wonderful dinner of FRESH VEGETABLES (did I mention how expensive and not-fresh the vegetables in the local store are??) and left over prime rib (from the DU dinner on Sat.) stir fry!

To continue the tale of the DU dinner…it was a lot of fun and I met a bunch of local people and the not-local doctor who was in from Anchorage’s Alaska Native Medical Center for his bi-annual visit to the island. I also saw my seat mate from the Penn Air flight in, the one with the bird. He also, I forgot to say, boarded the plane with a big honking knife on his belt, but hey, no problem. Terrorists don’t come to Sand Point, AK; there is plenty of home grown terror right here just starting bonfires. More on that later…Much money was spent on raffle tickets and the auction to support waterfowl habitat conservation, and many people went home well armed, since much of what was up for bid was fire arms.

After dinner we went to the beach just next to the airport—my preceptor, Laura, the diabetic educator Louise, the traveling PA Thai Verzone, the doc, and my next door neighbors Evan (21 and going fishing for the first time—I mean working on a commercial boat) and his roommate, the one local cop, Shane, 22. The weather was incredibly lovely, probably in the low 50s, very calm and of course light for a long time. The pictures were taken around 10 PM, and some of our group was out until after midnight with a bonfire in the twilight of 12 AM. The doc, Louise, and I (whose body was saying it was really 1130 PM) decided we just couldn’t stay up for the bonfire, so we were given a ride home in the back of the patrol car. We didn’t get handcuffed, but we did have to put on our seatbelts. The doc sensibly decided at the outset of the bonfire planning that bad decisions were about to be made, and that he should probably go back and wait at the clinic for the inevitable burn injuries, given that the entire rest of the health care providers were now at the bonfire except for one of the Community Health Aids. Apparently when Shane returned to the beach, he felt that the fire was not progressing sufficiently so he added several cups of gasoline and used a flare on it. He was on duty in full uniform, mind you. But Laura saved the day when she told Shane that if he didn’t put down the gasoline and back away she was going to walk home. And never take his dog for a walk again. She lives above me in the upstairs apartment and Shane and Evan and Casanova live next to me. So we had no emergency calls that night.

The next day I went on a long, gorgeous hike with Laura. See pictures below:

Monday morning started the clinic day and I shadowed Laura with a few patients, got to know where everything was and got to know some of the other staff there. I thought Laura was the only health care provider there, but actually there is usually one other midlevel (Nurse Practitioner or Physician Assistant) there. They have an NP who works on contract with 5 months on, then 1 month off, so while she and her family are in Montana, I’m staying in her apartment, and Thai is taking her place for a couple of weeks. Thai works throughout the Aleutians, Pribilofs and in Anchorage and even in Antarctica. He is really great and has been very patient with me and good at teaching. He is one good looking guy, too! Half Italian and half Vietnamese, 36 and single. I’m trying to match make him with one of my younger friends because he’s just too good to be going to waste and I want to be able to stay in touch with him. My preceptor is stellar, and I feel so lucky to be with someone who is so proficient, so good at teaching and so much fun to hang out with! We have a lot in common, and I am learning a lot from her. She’s made me feel very welcome. I don’t think they have had a lot of students here, so I hope that I can make a good impression and pave the way for more students.

The clinic also has two Community Health Aids, which is a program that I think is still unique to AK but probably will be exported to other Tribal health entities in the lower 48. They are community members who go through a very rigorous training program and function as health care providers under the supervision of a physician or mid level. But often the “supervision” is via phone, and they have a very detailed book that leads them step by step through physical exam, history taking, what to do next, etc. There are two of them here, and they see patients just like the mid levels, but have to consult with us if they need to prescribe medications or have a condition that needs higher level evaluation. They are amazing! All the providers here have to do their own lab draws and tests, own x-rays, own EKGs, plus we are the staff for the ER in the clinic. There is also a local Ambulance service and EMTs.

About half the island’s year round population has some native blood, but there are almost no full blooded Aleuts left anywhere. Many people here I would not have guessed had native blood and consider themselves native, but they have a distinctive style of speech that clues you in even if they don’t appear particularly native.

We had a tundra fire on Tuesday, when someone decided it would be fun to set off some flares down on the beach near one of the areas where there are a lot of houses just above. It really took off for a few hours, and we ended up with an ER patient with smoke inhalation, dehydration and exhaustion. The tide was too far out for the fireboat to be effective, and digging line through tundra is a losing battle. They put some hose lays out and finally got a couple of coast guard planes with retardant and did some drops. The next day it started raining and hasn’t quit, so it probably won’t hold over. We all walked down and watched the fire. One of our elderly patients lives down there, and her pug (Mr. Beefy—with a pink collar) tagged along and apparently felt it was his duty to supervise the hose lays. According to Mary, he returned quite late, very dirty, and smelling of smoke.

Tomorrow we’re having a luau at lunchtime, and I still have studying to do, so I will close for now. I have internet at the apartment but it’s pretty slow, so I probably won’t do much from there. The connection is faster at the clinic, so I have to go over there to do all my homework. I miss home but I’m still feeling the high adventure here! Send good coffee, whole grain granola bars and dark chocolate!

More pictures

NOT a typical house (left); Trident Cannery (below)

More pictures:

Alaska days 1 and 2

The harbor (left) and Laura Clark below

I made it! Actually it was a pretty easy trip--Cole and Victoria brought me to Spokane on Thursday afternoon where I spent the night with my friend Julie. Then the cab picked me up at 0515 for the trip to the airport, where I flew out at 0700. The entire trip was sunny until the very last part, when low-lying clouds covered Popof Island and we had to dip down under them to land. If you can think of every synonym for big that you've ever run across, it still won't describe the sheer magnitude of this incredible landscape that is Alaska!

I flew over the most beautiful enormity of snow-and-glacier-covered mountains to land in Anchorage (almost missed my flight in Seattle due to gate changes at the last minute) around 1100 Alaska time, which is an hour earlier than Idaho time. So I got a do-over of one hour! Waiting in the gate area for the little regional air carrier, Pennisula Air, was definite proof that I had arrived in Alaska. There was no security check, just had to show your id with your boarding pass and traipse out across the tarmac to a 30 passenger turboprop. My seatmate was a long tall red bearded kid who had made a cage for his cockatiel out of a milk crate, and was able to just barely shove the poor bird under the seat in front of him. He was heading to Sandpoint to fish on his brother's boat. The stewardess handed out ear plugs all around, and it quickly became obvious why. Although noisy, it was really a pretty easy flight over the 600 miles of peninsula and islands from Anchorage to Sand Point, alternating between flying over water, brown tundra and snow-covered peaks, with the occasional ancient caldera.

From what I could see it appeared that we must have had acquired pontoons that I didn't see when we took off, because I was pretty sure that we were landing on the water. It turned out that we did kind of an aircraft carrier landing, minus the bungee cords, flipped a U-turn at the end of the runway and taxied back to a small metal building, the Penn Air terminal. My preceptor, Laura Clark, picked me up in the Eastern Aleutian Tribes pickup, and we headed to the town, passing huge stacks of crab pots and fish traps sitting along the road waiting for the fishing season to start. We went down to the harbor to see a french couple and their 7 year old daughter who were traveling the world in an old tugboat, and were leaving the next day. The tug was pretty big, painted a nice red and was the Le Manguier out of Corsica. They had crossed along the top of Russia and come down the Bering Sea just ahead of the ice last October, spending the winter moored in the harbor here.

We talked to several people who were busily working on their boats, getting ready for the season to start, and later that day saw one of them in the ER at the clinic. He thought it might be paint fumes, but turns out something is wrong with his heart. But with fishing season coming up, he won't agree to see a cardiologist, so we told him to stay down off the tall masts!

I also saw my first case of scabies. Poor guy slept in a boat bunk that apparently wasn't the cleanest! I saw him again at the local latte shop today, and he greeted me cheerily. I didn't say, "How's your scabies?" since he was with some fisherman buddies. I'm pretty sure that's a HIPPA violation, not to mention downright rude.

Everyone here has been so warm and friendly and welcoming! I have a fully furnished 3 bedroom apartment just a 4 minute walk from the clinic, and it has a phone and wireless internet. Unfortunately, not only have I not been able to make the internet connect, we also disabled Laura's connection (she's my upstairs neighbor) in the process of trying to figure out what the right password was for me. So I'm at the clinic, just finished part of the homework that is due on Monday, and will be leaving soon to attend the Ducks Unlimited banquet this evening. I'm Laura's date, since it was $75 for a couple or $50 for a single. The contract physician's assistant, a wonderful young man named Thai, is also our date because he doesn't want to be the date of the village physician who is making his semi-annual visit this week.

I took a long walk around today, covered at least 3/4 of the road system on the island in less than 2 hours, and made friends at the latte shop, did a little VERY expensive grocery shopping (come on CSA box!) and petted a few free range dogs, waved at all the vehicles that passed me and took some pictures that I'll try to post here. If I fail this time, I'll do it tomorrow. Stand by for more adventures!

Thursday May 13, T minus 1 week and counting (what does that T stand for anyway??). Oh my badness, my list of things to do before I leave is completely insurmountable! Time for triage...

But on a good note, I did have my fingerprints redone, and right on the card the fingerprint taker wrote, "BEST PRINTS OBTAINABLE". And the very next day, my preceptorship registration paper with the shiny gold seal of Alaska affixed to it arrived in my mailbox. Did I mention that I also already HAD my Alaska R.N. license when the fingerprint rejection letter came? So apparently Alaska isn't really thinking that I am a terrorist or closet pedophile, it's just one of those things that has to be done. So at this point, I'm going up there and going to practice Nurse Practitioning (that's what we do, near as I can figure, since we can't practice MEDICINE because the physicians have that word copyrighted) with my mentor and preceptor, Laura Clark. And if they want to rescind my permission slips, they will have to fly out from Anchorage and pry them out of my old, wrinkled, worn out fingers.

At least one of the packages I mailed up there has arrived, according to Laura. I'd been advised by two of the people there to mail up anything I could stuff into flat rate boxes, like beans, rice, herbs, toilet paper...which they told me is $45 for a 9 roll pack...gack! $6.oo loaves of bread (probably white bread, too), $8.00 gallons of milk...So I was able to remove the inner cardboard roll, a la backpacking style, and fit 12 rolls, a roll of paper towels, and a whole box of Kleenex without the box, along with various herbs and spices, my reuseable coffee filter, beans, rice, Kashi granola bars, powdered milk for cooking, and I don't even remember what else into two boxes. I just ordered Cafe Mam coffee to be sent up there, and get this--I will be getting a Full Circle Farm CSA box of fresh, organic produce every other week, delivered to the island from Seattle, for $54 a box! I plan to eat local fish, Seattle vegetables, beans, oatmeal, and rice the whole time I'm there. And Cafe Mam coffee. With granola bars for dessert.

I met two people in my classes this week that grew up in Anchorage and were quite frankly puzzled as to why I'd want to go up there--not to mention CONSIDER actually living there after I graduate. They grew up in Anchorage though--people tell me that isn't really Alaska. One says she'd much rather live in Hawaii, so to each their own I guess. 30 below isn't that much colder than 15 below, which we get just about every winter here. Ok, mosquitoes as big as pterodactyls isn't all that inviting, but every place has its trials! Maybe if you grew up working outside and have worked outside in every kind of weather for most of your life, weather just isn't as daunting. Now rain--there's weather with no recreational value whatsoever! Give me snow any day...but hopefully not this summer while I'm there.

Stay tuned! And the mailing address there, which a few people have asked me for, is: C/O Eastern Aleutian Tribes Clinic, POB 172, Sand Point, AK 99661.

Aerial view of Sand Point, AK

Hmmm....does resemble Sandpoint, Idaho to some degree...

In the beginning...

there were many commandments, and the commandments all involved much paperwork and wailing and gnashing of teeth, and verily there were many sets of fingerprints generated and rejected, yea unto the 8th or 9th iteration of such. And the hands of this hardworking, bundle-toting, garage-sale implementing, dirt-scrabbling, hand-washing woman were nearly devoid of usable fingerprints, though she had been fingerprinted many times since entering the health care profession, none of which had borne fruit nor yielded up evidence of any wrongdoing (for Pete's sake, I've never even had a traffic ticket except for in Montana where it's not even a moving violation, just a resource conservation violation for driving too fast, and well worth the $5 for the privilege of driving as fast as you want in the absence of posted speed limits. But I digress...).

And it came to pass that yet another set was required of her to obtain a "preceptor registration" from the state of Alaska, though she had already obtained an R.N. license from that state, with it's multiplicity of requirements and proofs that might indicate to the unknowing that there is, in fact, a GLUT of R.N.s already practicing in said state. Two previous sets of fingerprints sent to Alaska had failed to pass muster, the first one when the entire contents of the application envelope having apparently swum to Anchorage unaided by boat or other conveyance; the second set (and an additional $15 fee for making them) were rejected by the FBI for poor quality. The fingerprints, not the fee.

Now, those fingerprints (did I say that which, in all the many other times I've been fingerprinted have never revealed any crime sprees?) are exactly what my fingertips look like. Worn down. Wrinkled. Old. Well used. No amount of lotion will change that. One could even venture to say that they are pretty unique, due to the above-mentioned characteristics. Just GO with them, FBI! They will NOT GET ANY BETTER! Tomorrow I go off to the Sheriff's office to have the nice lady ink another set, and that is really the only hurdle I have left to being able to do this clinical in Alaska. Stay tuned for more progress reports, and if all goes well, I'll be on a plane heading north early in the day of May 21, 2010.